Tuesday, 5 February 2019

Questions (52)

John Curran


52. Deputy John Curran asked the Minister for Health the provision he will make for home support services for the elderly in view of the significant increase in the number of persons waiting for home support services; and if he will make a statement on the matter. [5026/19]

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Oral answers (6 contributions) (Question to Health)

The Minister will recall that in 2018 many people had significant difficulties in accessing home support services, particularly elderly people and those who had been discharged from hospital. What level of provision of home support services is the Minister making available in 2019 in recognition that last year there was a constant significant waiting list for services?

Home support is an important support that enables older people to remain in their homes and communities for as long as possible. It also facilitates timely discharge from acute hospitals. As a Government, we have made improved access to home support services a key priority. In the past four years we have seen sustained investment in these services, with a considerable increase of nearly €140 million in the budget, which has grown from €306 million in 2015 to almost €446 million this year.

The HSE's national service plan provides for a target of almost 18 million home support hours to be provided to 53,182 people. This represents an increase of 800,000 hours and home support for 2,682 more people over last year's target. In addition, 235 intensive home care packages will provide 360,000 home support hours for people with complex needs. Despite this significant level of service provision, demand continues to rise.

While the existing home support service is delivering crucial support to many people throughout the country, it needs to be improved to better meet the changing needs of people. That is why we propose to establish a statutory scheme for home support which will improve access to the service and put it on an affordable and sustainable basis, while also introducing a system of regulation that will ensure public confidence. This is a significant and complex undertaking, and the Sláintecare implementation strategy commits to the introduction of the statutory scheme in 2021.

I thank the Minister of State for his reply. I acknowledge the increase in figures he has outlined. It is fair to say that last year was problematic. It is an indication that we have an ageing population that is growing. Most public representatives would have had an increased number of people presenting at their offices looking for support.

The Minister of State has indicated that there will be home support services for 53,000 people. Last year the budget was for 50,500. Most times we asked questions, there were 52,000 to 52,500 people in receipt of service. At the same time, there were 6,000 to 7,000 on a waiting list. If the 52,500 is added to 6,500, there were 59,000 people looking for home support services at any given time. Making a service for 53,000 available does not seem sufficient to meet current need. Will the Minister of State look at that in the context of the constant demand last year, where hours were being recycled or diminished, and in the context of the problem for elderly people in hospital in particular where they are trying to come home and that demand is not being met by the number of hours being made available?

I would be the first to acknowledge that we will not meet the demand that will be there this year. We do not have an infinite budget and there are many competing demands that we discuss all day every day on the floor of this House such as more pay for the nurses, the drugs we want approved and so on. There are so many competing budgets, and this is just one more cog in that wheel, but €140 million over a four-year period is a very significant increase by any standard. It has allowed for an increase of 800,000 home help hours this year. I can categorically and regrettably state that we will not meet the demand for home help this year. There is no point in my pretending to dress that up in any way. I am sure the Deputy and I will have this conversation again during this year and that we will debate it many times during Leaders' Questions, but we have a finite budget and, as in all the other areas, the demands are increasing. That is why we have undertaken to do a statutory home care scheme where we can provide to everybody. That is our ambition for 2021 and significant work has been done, even by the Health Research Board, looking at Germany, Sweden, Scotland the Netherlands where they have similar schemes in operation. We are trying to build a scheme along those lines. That is complex challenge.

I recognise that the Minister of State does not have an infinite budget and has to work within constraints. In that regard we need to consider how things are done. For somebody who on a delayed discharge from hospital, there is an opportunity cost. When I asked a parliamentary question and got a response from the HSE, I was told that the number of direct employees of the HSE providing home services is reducing. The dependency on agencies to provide this type of service is increasing. Does the Minister of State believe that is the best value for money rather than having direct employees? Is there scope to examine that and increase capacity?

Something peculiar has been going on in my area, which falls under community healthcare organisation, CHO 7, that needs to be addressed. In March 2018, there were 724 people waiting for home support services, but by August that figure had gone up by over 50% to more than 1,100 people. That is out of kilter with all of the other figures. I do not expect the Minister of State to have the response here but I would like him to consider it directly. In terms of cost saving, will an analysis be done between using agency staff with a diminishing number of HSE direct employees, which had been the previous model? Would that be a way to provide additional hours?

We will try to get the best value for and best utilisation of the limited budget we have. While I have not focused on managing the existing system, neither have I directed many officials to spend time on that. I could start tinkering around the edges of the existing system, but there are problems with training and regulation, supply and the postcode lotteries, as they are referred to. There are myriad challenges in the existing system. I have taken the political decision to move away from that and develop, from the ground up, a new system that is fit for purpose and that will address many of these issues collectively.

I will certainly look into the disparity in the Deputy's area that he asked about. It seems unusual for it to jump by 50%, particularly in those months.

The Minister, Deputy Harris, has asked me to chair an implementation body on delayed discharges, so that is an area in which I have a particular interest. I absolutely accept the financial point the Deputy makes that we can be penny wise and pound foolish, but there is a cost basis to this and we will be considering that. I will focus keenly on that with a view to tackling the issue of delayed discharges in the acute hospital system, because I have responsibility for the home care service. I will come back to the Deputy about his local query.